Learning about growing older

A new word has been coined — “geroscience” — to describe the intensified focus on studying the human aging process and figuring out what to do about it.

By BARBARA PETERS SMITH

Florence Katz's desk calendar is black with ink, nearly every hour filled, and she checks it faithfully each morning.

On Wednesdays and Fridays she works as the volunteer “disher-outer” at lunches for homebound elders at the Jewish Family & Children's Service of Sarasota-Manatee. Add to this her weekly card games, her nightly reading, her practice on the violin and viola, her attendance at the opera, symphony and various fundraisers, and all the activities offered by her retirement community, the Sarasota Bay Club.

At 4-foot-8 and about 76 pounds, she doesn't take up much space in this world. But she's been in it for more than 98 years, and she rarely allows herself to slow down.

“There's one thing that I tell myself: 'You're not going into the rocking chair, and you're not going to use a cane,' ” she says. “And so far, I'm listening to myself.”

Katz is one of those fortunate people whose “healthspan” has kept up with her impressive life span, sparing her from most disabilities that limit quality of life for many who are decades younger. She is the kind of dynamic elder that researchers are studying for clues about how the rest of us might age more gracefully and healthfully. And she is paying attention to the science herself.

“In my brain class they said that if you eat green vegetables it helps the brain,” she says. “I'm doing everything to keep my brain going.”

The graying of America and the developed world is now such a widely recognized phenomenon that a new word has been coined — “geroscience” — to describe the intensified focus on studying the human aging process and figuring out what to do about it.

A few of the distinguished geroscientists meeting in Washington for a November summit told U.S. Senate members that their goal is to increase the human healthspan to match and enrich our longer life spans. There are now more people over 60 than under 15, said Michael Hodin, executive director of the Global Coalition on Aging, and this phenomenon is “baked in for the next two generations.”

“In 2020,” Hodin told the Senate Subcommittee on Aging, “the Japanese will sell more adult diapers than baby diapers.”

It is an image that captures the obvious challenges of an aging society. But the diaper comparison ignores a still-unresolved — and hotly debated — question about the dramatic rise in human life expectancy: Will it continue, or has it peaked?

Will the cohort that came of age around World War II be the last generation in developed nations whose members live into their 90s and 100s in such great numbers — or will breakthroughs in medicine and technology lengthen life spans even more for the generations coming after these aging pioneers?

For now, no one can say why so many in the “golden cohort” — people born in certain countries in the years just before and after 1930 — have survived to such a ripe old age. One theory has to do with food shortages in the years surrounding World War II, since caloric restriction has been shown to extend longevity in laboratory mice.

Katz, who has far outlived others in her family, suspects her severe allergy to wheat may have helped her stay fit. She has never smoked, keeps her medications to a minimum, and sleeps four or five hours a night.

“I don't know what my vices are,” she says. “I probably have some vices, but I'm not conscious of it.”

Researchers who think the obesity epidemic and other factors will derail current longevity trends suspect that this one generation has broken records that the baby boomers won't match.

“These individuals approaching retirement age are more disabled and more frail than the generations that preceded them,” said Jay Olshansky, a professor of epidemiology at the University of Illinois at Chicago. “There isn't much room left for improvement. That's critical for those of us who study the future of longevity.”

The stunning advance in life expectancies over the last century stems from two crucial developments: public health measures, such as the polio vaccine, that lowered the mortality rate for children; and medical treatment breakthroughs that extended life for people with once-fatal diseases like heart failure or cancer.

Life expectancy is an inexact calculation that tries to predict your remaining life span , depending on when you were born and how old you are now. If you were a 65-year-old American in 1930, for example, you could expect another 12.2 years of life. If you are 65 now, the figure is more like 18.5 years.

But Olshansky — speaking at a recent Age Boom Academy for journalists hosted by Columbia University — said these predictions, based on historical trends, tend to lag behind reality.

“Up until 1977, we dramatically underestimated life expectancy,” he said. “After 1980, we started making the opposite mistake.” In periods when mortality rates creep back up, he explained, the formula “overestimates life expectancy. I think we're there.”

Take Japan, land of the rising market in adult diapers. While birth rates remain low, shifts toward Western diets and more sedentary lifestyles may be chipping away at the number of citizens who will see the other side of 85.

“A lot of my colleagues believe that especially in Japan, life expectancy is on the brink of a decline,” Olshansky said. “There is evidence to suggest that these younger generations, especially in parts of Japan where obesity has increased, will see their life spans decline.”

The counterargument — that still-to-come medical discoveries and technologies will continue to suppress mortality rates, and that there is no real upper limit to the human life span — is led by James Vaupel of the Max Planck Institute for Demographic Research in Rostock, Germany. He is said to be so opposed to Olshansky's views that he declines to appear at the same scientific conferences.

Vaupel's theory is that what he calls “the frontier of survival” is continually advancing, pushed along by rising numbers of humans who live past 100. His argument reflects current social assumptions that aging is relative, and that 50, for example, is the new 40 or even 30.

“We are making progress in bringing death rates down, even at the highest ages,” he said in a recent lecture. “Aging is being postponed; it's not being slowed down. The health that people used to have at age 70, they're now having at 80 or 90.”

While this may be true on an individual level — especially for individuals at higher levels of education and wealth — there are signs of an emerging longevity gap, at least in the United States. This suggests that the constantly receding frontier that Vaupel envisions may not apply across the board.

An influential paper last year by Olshansky and his colleagues with the MacArthur Foundation's Research Network on an Aging Society identified a group of Americans — white females with fewer than 12 years of schooling — for whom life expectancy actually declined between 1990 and 2008.

Olshansky and others also question whether extended life spans since the early 1900s have come at an unacceptable price. Fewer adults now die naturally “of old age” — instead, most linger for years while struggling with a host of debilitating conditions.

“We got 30 years, but we traded them off for heart disease, cancer, stroke and Alzheimer's — all the things we don't like,” Olshansky said. “If we succeed in continuing to reduce the risk of major fatal diseases, we will get something else. We're pushing the life span into those regions where frailty and disability are extremely high. There is much less plasticity in what we can do to improve health at older ages.”

While demographers on both sides of the longevity debate wait for evidence that they are right, geroscientists are concentrating on healthy supercentenarians — people older than 100 with minimal disabilities — to find clues on how to delay the toll that aging usually takes.

The MacArthur network of aging researchers produced another paper in Health Affairs in October, saying that slowing the aging process is a realistic goal that could increase life expectancy by 2.2 healthful years, and estimating the economic value of such an accomplishment at $7.1 trillion over the next half-century.

“If we think about this 30-year increase in life expectancy over the last 100 years, it offers us a new stage we've never lived before and we're not very well prepared for it,” says Linda P. Fried, dean of the Mailman School of Public Health at Columbia University. “Preparation could actually lead to a pretty great outcome, but lack of preparation can lead to policies and decisions based on our fears, which is not so good.”

Dietary manipulation — like adding to the life spans of mice by limiting their intake — has received much attention in the anti-aging field, along with stem cell and molecular research. Another rich possibility is the study of ways to stem inflammation, as Dr. Richard Hodes, director of the National Institute on Aging, told the Senate panel recently.

“Several epidemiological studies indicate that high blood levels of inflammatory biomarkers are the most significant risk factor for both morbidity and mortality in the elderly,” he said. “However, many unanswered questions remain about the etiology of age-associated inflammation — whether inflammation is a cause or consequence, or both, of disease.”

By far the most promising path at this point for extending life in a meaningful and enjoyable way, the researchers agree, lies in early intervention. This involves helping people establish good health habits while they're young — before obesity and sedentary lifestyles can start to erode life expectancy.

Florence Katz shares one characteristic — a college education — that is emerging as a marker for those on the high side of the longevity gap. The rest she credits to relentless momentum, and an abiding gratitude for the time she's been allowed.

“I just go from day to day,” she says. “When I get up in the morning and I look at the sky, I say, 'Thank God I'm here. How can I make the most of today? — because I don't have tomorrow.' I've done this all my life, but it becomes more accentuated the older I get.

“You have to appreciate the blue sky, and the stars in the sky; you have to be thankful for it.”